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Efficacy Study of Nivolumab Plus Ipilimumab or Nivolumab Plus Chemotherapy Against Chemotherapy in Stomach Cancer or Stomach/Esophagus Junction Cancer

A Randomized, Multicenter, Open-Label, Phase 3 Study of Nivolumab Plus Ipilimumab or Nivolumab in Combination With Oxaliplatin Plus Fluoropyrimidine Versus Oxaliplatin Plus Fluoropyrimidine in Subjects With Previously Untreated Advanced or Metastatic Gastric or Gastroesophageal Junction Cancer

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02872116
Acronym
CheckMate649
Enrollment
2031
Registered
2016-08-19
Start date
2016-10-12
Completion date
2024-06-06
Last updated
2025-08-07

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Esophageal Adenocarcinoma, Gastric Cancer, Gastroesophageal Junction Cancer

Brief summary

The main purpose of this study is to compare how long patients with gastric or gastroesophageal junction cancer live after receiving nivolumab and ipilimumab or nivolumab and chemotherapy compared with patients receiving chemotherapy alone.

Interventions

DRUGNivolumab

Specified dose on specified days

DRUGIpilimumab

Specified dose on specified days

DRUGOxaliplatin

Specified dose on specified days

DRUGCapecitabine

Specified dose on specified days

DRUGLeucovorin

Specified dose on specified days

DRUGFluorouracil

Specified dose on specified days

Sponsors

Ono Pharmaceutical Co. Ltd
CollaboratorINDUSTRY
Bristol-Myers Squibb
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Male or Female at least 18 years of age * Must have gastric cancer or gastroesophageal junction cancer that cannot be operated on and that is advanced or has spread out * Did not receive neoadjuvant or adjuvant treatment (chemotherapy, radiotherapy, or both) for their disease within the last 6 months * Must have full activity or, if limited, must be able to walk and carry out light activities such as light house work or office work * Must agree to provide tumor tissue sample, either from a previous surgery or biopsy within 6 months or fresh, prior to the start of treatment in this study

Exclusion criteria

* Presence of tumor cells in the brain or spinal cord that have not been treated * Active known or suspected autoimmune disease * Any serious or uncontrolled medical disorder or active infection * Known history of positive test for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS) * Any positive test result for hepatitis B or C indicating acute or chronic infection Other protocol-defined inclusion/

Design outcomes

Primary

MeasureTime frameDescription
Overall Survival (OS) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy With PD-L1 CPS ≥ 5From the date of randomization up to the date of death, up to approximately 17 monthsOverall survival (OS), defined as the time from randomization to the time of death, in participants treated with Nivolumab plus Chemotherapy vs Chemotherapy with PD-L1 CPS (combined positive score) ≥ 5. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.
Progression Free Survival (PFS) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy With PD-L1 CPS ≥ 5From randomization to the date of the first documented progressive disease (PD) per BICR or death due to any cause (up to approximately 10 months)Progression Free Survival (PFS) is defined as the time from randomization to the date of the first documented PD or death due to any cause. PD is determined by blinded independent committee review (BICR) per RECIST1.1 criteria in participants treated with Nivolumab plus Chemotherapy vs Chemotherapy with PD-L1 CPS ≥ 5. Progressive disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking in reference the smallest sum on study that also demonstrated an absolute increase of at least 5 mm. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.

Secondary

MeasureTime frameDescription
Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyFrom randomization to the date of objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first (up to approximately 43 months)Objective response rate (ORR) as assessed by BICR in participants with PD-L1 CPS ≥ 10, 5, 1, or all randomized participants. ORR is a percentage of participants determined by the number of participants with a best overall response (BOR) of complete response (CR) or partial response (PR) divided by the number of measurable participants with target lesion at baseline. BOR is defined as the best response designation as determined by the BICR, recorded between the date of randomization and the date of objectively documented progression (per RECIST 1.1 as determined by the BICR) or the date of subsequent anti-cancer therapy, whichever occurs first. CR is defined as the disappearance of all target lesions. PR is define as at 30% decrease in the sum of diameters of target lesions. The 806 chemotherapy treated participants are split into two separate arms (Arm 2a and Arm 2b) to act as comparison groups to the other treatment arms.
Time to Symptom Deterioration (TTSD) in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyFrom randomization until a clinically meaningful decline from baseline in GaCS score (approximately 10 months)TTSD is defined as the the time from randomization until a clinically meaningful decline from baseline in Gastric Cancer Subscale (GaCS) score. A clinically meaningful deterioration is defined as a reduction of 8.2 points in the GaCS score. Subjects who do not deteriorate will be censored at the time of their last GACS assessment. Subjects without baseline GaCS assessment will be censored on the randomization date. Those with baseline GaCS, who do not have any GaCS assessments after randomization will be censored on the day after randomization.
OS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyFrom the date of randomization up to the date of death, up to approximately 17 monthsOverall survival (OS), defined as the time from randomization to the time of death, in participants treated with Nivolumab plus Chemotherapy vs Chemotherapy with PD-L1 CPS ≥ 1, 10, and all randomized participants. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.
PFS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyFrom randomization to the date of the first documented progressive disease (PD) per BICR or death due to any cause (up to approximately 9 months)Progression Free Survival (PFS) is defined as the time from randomization to the date of the first documented PD or death due to any cause. PD is determined by blinded independent committee review (BICR) per RECIST1.1 criteria in participants treated with Nivolumab plus Ipilumab vs Chemotherapy with PD-L1 CPS ≥ 10, 5, 1 or all randomized participants. Progressive disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking in reference the smallest sum on study that also demonstrated an absolute increase of at least 5 mm. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.
Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyFrom randomization to the date of objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first (up to approximately 43 months)Objective response rate (ORR) as assessed by BICR in participants with PD-L1 CPS ≥ 10, 5, 1, or all randomized participants. ORR is a percentage of participants determined by the number of participants with a best overall response (BOR) of complete response (CR) or partial response (PR) divided by the number of measurable participants with target lesion at baseline. BOR is defined as the best response designation as determined by the BICR, recorded between the date of randomization and the date of objectively documented progression (per RECIST 1.1 as determined by the BICR) or the date of subsequent anti-cancer therapy, whichever occurs first. CR is defined as the disappearance of all target lesions. PR is define as at 30% decrease in the sum of diameters of target lesions. The 806 chemotherapy treated participants are split into two separate arms (Arm 2a and Arm 2b) to act as comparison groups to the other treatment arms.
OS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyFrom the date of randomization up to the date of death, up to approximately 14 monthsOverall survival (OS), defined as the time from randomization to the time of death, in participants treated with Nivolumab plus Ipilimumab vs Chemotherapy with PD-L1 CPS (combined positive score) ≥ 1, 5, 10, and all randomized participants. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.
PFS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyFrom randomization to the date of the first documented progressive disease (PD) per BICR or death due to any cause (up to approximately 10 months)Progression free survival (PFS), defined as the time from randomization to the date of the first documented progressive disease (PD) or death due to any cause, in participants treated with Nivolumab plus Chemotherapy vs Chemotherapy by BICR per RECIST1.1 in participants with PD-L1 CPS ≥ 10, 1, or all randomized subjects. Progreessive disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking in reference the smallest sum on study that also demonstrated an absolute increase of at least 5 mm. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.

Countries

Argentina, Australia, Brazil, Canada, Chile, China, Colombia, Czechia, France, Germany, Greece, Hong Kong, Hungary, Israel, Italy, Japan, Mexico, Peru, Poland, Portugal, Romania, Russia, Singapore, South Korea, Spain, Taiwan, Turkey (Türkiye), United Kingdom, United States

Participant flow

Pre-assignment details

2031 Participants Randomized and 1991 Treated

Participants by arm

ArmCount
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)
Nivolumab + Xelox: Nivolumab 360 mg IV over 30 minutes on Day 1 of each treatment cycle, every 3 weeks + Oxaliplatin 130 mg/m2 IV on Day 1 of each treatment cycle + capecitabine 1000 mg/m2 orally twice daily (ie, 1000 mg/m2 in the morning and 1000 mg/m2 in the evening) on Days 1 to 14 of each treatment cycle, every 3 weeks Nivolumab + Folfox: Nivolumab 240 mg IV over 30 minutes on Day 1 of each treatment cycle, every 2 weeks + Oxaliplatin 85 mg/m2 + leucovorin 400 mg/m2 + fluorouracil 400 mg/m2 IV on Day 1 of each treatment cycle, and fluorouracil 1200 mg/m2 IV continuous infusion over 24 hours (or per local standard) daily on Days 1 and 2 of each treatment cycle, every 2 weeks
789
Arm 2: Chemotherapy (XELOX or FOLFOX)
Chemotherapy (XELOX or FOLFOX): Xelox: Oxaliplatin 130 mg/m2 IV on Day 1 of each treatment cycle + capecitabine 1000 mg/m2 orally twice daily (ie, 1000 mg/m2 in the morning and 1000 mg/m2 in the evening) on Days 1 to 14 of each treatment cycle, every 3 weeks. Folfox: Oxaliplatin 85 mg/m2 + leucovorin 400 mg/m2 + fluorouracil 400 mg/m2 IV on Day 1 of each treatment cycle, and fluorouracil 1200 mg/m2 IV continuous infusion over 24 hours (or per local standard) daily on Days 1 and 2 of each treatment cycle, every 2 weeks. This chemotherapy group consists of the two comparison chemotherapy sub-groups. Arm 2a (792 participants) is the comparison group to Arm 1 and Arm 2b (404 participants) is the comparison group to Arm 3. Some participants were counted in both Arm 2a and Arm 2b.
833
Arm 3: Nivolumab + Ipilimumab
1 mg/kg nivolumab administered IV over 30 minutes followed by ipilimumab 3 mg/kg administered IV over 30 minutes on Day 1 of each treatment cycle every 3 weeks for 4 doses (Cycles 1 to 4), followed by nivolumab 240 mg administered IV over 30 minutes on Day 1 of each treatment cycle every 2 weeks (Cycle 5 and beyond). Arm is closed to enrollment as of 05-June-2018.
409
Total2,031

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Pre-TreatmentAdverse event unrelated to study drug021
Pre-TreatmentDisease Progression010
Pre-TreatmentOther reasons122
Pre-TreatmentParticipant no longer meets study criteria400
Pre-TreatmentParticipants request to discontinue study treatment020
Pre-TreatmentParticipant withdrew consent2203
TreatmentDeath1219468
TreatmentLost to Follow-up573
TreatmentOther reasons13125
TreatmentParticipant withdrew consent20408

Baseline characteristics

CharacteristicArm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)Arm 2: Chemotherapy (XELOX or FOLFOX)Arm 3: Nivolumab + IpilimumabTotal
Age, Continuous60.3 Years
STANDARD_DEVIATION 11.9
59.8 Years
STANDARD_DEVIATION 12.1
59.4 Years
STANDARD_DEVIATION 11.7
59.9 Years
STANDARD_DEVIATION 12
Race (NIH/OMB)
American Indian or Alaska Native
12 Participants13 Participants1 Participants26 Participants
Race (NIH/OMB)
Asian
186 Participants200 Participants124 Participants510 Participants
Race (NIH/OMB)
Black or African American
7 Participants11 Participants6 Participants24 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
28 Participants39 Participants14 Participants81 Participants
Race (NIH/OMB)
White
556 Participants570 Participants264 Participants1390 Participants
Sex: Female, Male
Female
249 Participants246 Participants131 Participants626 Participants
Sex: Female, Male
Male
540 Participants587 Participants278 Participants1405 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
691 / 782741 / 806361 / 403
other
Total, other adverse events
763 / 782756 / 806369 / 403
serious
Total, serious adverse events
529 / 782474 / 806307 / 403

Outcome results

Primary

Overall Survival (OS) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy With PD-L1 CPS ≥ 5

Overall survival (OS), defined as the time from randomization to the time of death, in participants treated with Nivolumab plus Chemotherapy vs Chemotherapy with PD-L1 CPS (combined positive score) ≥ 5. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.

Time frame: From the date of randomization up to the date of death, up to approximately 17 months

Population: All randomized participants with PD-L1 CPS ≥ 5

ArmMeasureValue (MEDIAN)
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)Overall Survival (OS) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy With PD-L1 CPS ≥ 514.39 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)Overall Survival (OS) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy With PD-L1 CPS ≥ 511.10 Months
p-value: <0.000198.4% CI: [0.59, 0.86]Log Rank
Primary

Progression Free Survival (PFS) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy With PD-L1 CPS ≥ 5

Progression Free Survival (PFS) is defined as the time from randomization to the date of the first documented PD or death due to any cause. PD is determined by blinded independent committee review (BICR) per RECIST1.1 criteria in participants treated with Nivolumab plus Chemotherapy vs Chemotherapy with PD-L1 CPS ≥ 5. Progressive disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking in reference the smallest sum on study that also demonstrated an absolute increase of at least 5 mm. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.

Time frame: From randomization to the date of the first documented progressive disease (PD) per BICR or death due to any cause (up to approximately 10 months)

Population: All randomized participants with PD-L1 CPS ≥ 5

ArmMeasureValue (MEDIAN)
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)Progression Free Survival (PFS) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy With PD-L1 CPS ≥ 57.69 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)Progression Free Survival (PFS) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy With PD-L1 CPS ≥ 56.05 Months
p-value: <0.000198% CI: [0.56, 0.81]Log Rank
Secondary

Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy

Objective response rate (ORR) as assessed by BICR in participants with PD-L1 CPS ≥ 10, 5, 1, or all randomized participants. ORR is a percentage of participants determined by the number of participants with a best overall response (BOR) of complete response (CR) or partial response (PR) divided by the number of measurable participants with target lesion at baseline. BOR is defined as the best response designation as determined by the BICR, recorded between the date of randomization and the date of objectively documented progression (per RECIST 1.1 as determined by the BICR) or the date of subsequent anti-cancer therapy, whichever occurs first. CR is defined as the disappearance of all target lesions. PR is define as at 30% decrease in the sum of diameters of target lesions. The 806 chemotherapy treated participants are split into two separate arms (Arm 2a and Arm 2b) to act as comparison groups to the other treatment arms.

Time frame: From randomization to the date of objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first (up to approximately 43 months)

Population: All randomized participants in various subsets as determined by PD-L1 CPS status

ArmMeasureGroupValue (NUMBER)
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with CPS ≥ 148.8 Percentage of Participants
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with CPS ≥ 550.1 Percentage of Participants
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with CPS ≥ 1048.8 Percentage of Participants
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyAll randomized participants46.9 Percentage of Participants
Arm 2a: Chemotherapy (XELOX or FOLFOX)Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyAll randomized participants37.2 Percentage of Participants
Arm 2a: Chemotherapy (XELOX or FOLFOX)Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with CPS ≥ 138.0 Percentage of Participants
Arm 2a: Chemotherapy (XELOX or FOLFOX)Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with CPS ≥ 1037.7 Percentage of Participants
Arm 2a: Chemotherapy (XELOX or FOLFOX)Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with CPS ≥ 538.2 Percentage of Participants
Secondary

Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy

Objective response rate (ORR) as assessed by BICR in participants with PD-L1 CPS ≥ 10, 5, 1, or all randomized participants. ORR is a percentage of participants determined by the number of participants with a best overall response (BOR) of complete response (CR) or partial response (PR) divided by the number of measurable participants with target lesion at baseline. BOR is defined as the best response designation as determined by the BICR, recorded between the date of randomization and the date of objectively documented progression (per RECIST 1.1 as determined by the BICR) or the date of subsequent anti-cancer therapy, whichever occurs first. CR is defined as the disappearance of all target lesions. PR is define as at 30% decrease in the sum of diameters of target lesions. The 806 chemotherapy treated participants are split into two separate arms (Arm 2a and Arm 2b) to act as comparison groups to the other treatment arms.

Time frame: From randomization to the date of objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first (up to approximately 43 months)

Population: All randomized participants in various subsets as determined by PD-L1 CPS status

ArmMeasureGroupValue (NUMBER)
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyParticipants with CPS ≥ 137.3 Percentage of Participants
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyParticipants with CPS ≥ 537.7 Percentage of Participants
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyParticipants with CPS ≥ 1035.9 Percentage of Participants
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyAll randomized participants34.9 Percentage of Participants
Arm 2a: Chemotherapy (XELOX or FOLFOX)Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyAll randomized participants20.8 Percentage of Participants
Arm 2a: Chemotherapy (XELOX or FOLFOX)Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyParticipants with CPS ≥ 121.7 Percentage of Participants
Arm 2a: Chemotherapy (XELOX or FOLFOX)Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyParticipants with CPS ≥ 1024.3 Percentage of Participants
Arm 2a: Chemotherapy (XELOX or FOLFOX)Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyParticipants with CPS ≥ 523.1 Percentage of Participants
Secondary

OS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy

Overall survival (OS), defined as the time from randomization to the time of death, in participants treated with Nivolumab plus Chemotherapy vs Chemotherapy with PD-L1 CPS ≥ 1, 10, and all randomized participants. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.

Time frame: From the date of randomization up to the date of death, up to approximately 17 months

Population: All randomized participants with available OS measurements in various subsets

ArmMeasureGroupValue (MEDIAN)
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)OS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyAll randomized participants13.73 Months
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)OS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with PD-LI CPS ≥ 113.80 Months
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)OS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with PD-L1 CPS ≥ 514.39 Months
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)OS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with PD-L1 CPS ≥ 1015.01 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)OS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with PD-L1 CPS ≥ 1010.94 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)OS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyAll randomized participants11.63 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)OS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with PD-L1 CPS ≥ 511.14 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)OS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with PD-LI CPS ≥ 111.37 Months
Secondary

OS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy

Overall survival (OS), defined as the time from randomization to the time of death, in participants treated with Nivolumab plus Ipilimumab vs Chemotherapy with PD-L1 CPS (combined positive score) ≥ 1, 5, 10, and all randomized participants. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.

Time frame: From the date of randomization up to the date of death, up to approximately 14 months

Population: All randomized participants with available measurements in various subsets as determined by PD-L1 CPS status

ArmMeasureGroupValue (MEDIAN)
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)OS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyAll randomized participants11.83 Months
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)OS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyParticipants with CPS ≥ 511.63 Months
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)OS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyParticipants with CPS ≥ 1011.33 Months
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)OS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyParticipants with CPS ≥ 111.47 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)OS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyParticipants with CPS ≥ 1011.63 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)OS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyAll randomized participants11.73 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)OS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyParticipants with CPS ≥ 111.73 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)OS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyParticipants with CPS ≥ 511.24 Months
Secondary

PFS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy

Progression free survival (PFS), defined as the time from randomization to the date of the first documented progressive disease (PD) or death due to any cause, in participants treated with Nivolumab plus Chemotherapy vs Chemotherapy by BICR per RECIST1.1 in participants with PD-L1 CPS ≥ 10, 1, or all randomized subjects. Progreessive disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking in reference the smallest sum on study that also demonstrated an absolute increase of at least 5 mm. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.

Time frame: From randomization to the date of the first documented progressive disease (PD) per BICR or death due to any cause (up to approximately 10 months)

Population: All randomized participants with available PFS measurements in various subsets

ArmMeasureGroupValue (MEDIAN)
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)PFS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyAll randomized participants7.75 Months
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)PFS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with PD-L1 CPS ≥ 58.31 Months
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)PFS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with PD-L1 CPS ≥ 17.52 Months
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)PFS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with PD-L1 CPS ≥ 108.41 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)PFS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with PD-L1 CPS ≥ 105.82 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)PFS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyAll randomized participants6.93 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)PFS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with PD-L1 CPS ≥ 16.93 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)PFS in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyParticipants with PD-L1 CPS ≥ 56.14 Months
Secondary

PFS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy

Progression Free Survival (PFS) is defined as the time from randomization to the date of the first documented PD or death due to any cause. PD is determined by blinded independent committee review (BICR) per RECIST1.1 criteria in participants treated with Nivolumab plus Ipilumab vs Chemotherapy with PD-L1 CPS ≥ 10, 5, 1 or all randomized participants. Progressive disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking in reference the smallest sum on study that also demonstrated an absolute increase of at least 5 mm. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.

Time frame: From randomization to the date of the first documented progressive disease (PD) per BICR or death due to any cause (up to approximately 9 months)

Population: All randomized participants with available measurements in various subsets as determined by PD-L1 CPS status

ArmMeasureGroupValue (MEDIAN)
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)PFS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyAll randomized participants7.06 Months
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)PFS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyPD-L1 CPS ≥ 16.93 Months
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)PFS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyPD-L1 CPS ≥ 56.28 Months
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)PFS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyPD-L1 CPS ≥ 106.28 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)PFS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyPD-L1 CPS ≥ 102.89 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)PFS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyAll randomized participants2.83 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)PFS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyPD-L1 CPS ≥ 52.83 Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)PFS in Participants Treated With Nivolumab Plus Ipilimumab vs ChemotherapyPD-L1 CPS ≥ 12.79 Months
Secondary

Time to Symptom Deterioration (TTSD) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy

TTSD is defined as the the time from randomization until a clinically meaningful decline from baseline in Gastric Cancer Subscale (GaCS) score. A clinically meaningful deterioration is defined as a reduction of 8.2 points in the GaCS score. Subjects who do not deteriorate will be censored at the time of their last GACS assessment. Subjects without baseline GaCS assessment will be censored on the randomization date. Those with baseline GaCS, who do not have any GaCS assessments after randomization will be censored on the day after randomization.

Time frame: From randomization until a clinically meaningful decline from baseline in GaCS score (approximately 10 months)

Population: All Treated participants with TTSD measurements

ArmMeasureValue (MEDIAN)
Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX)Time to Symptom Deterioration (TTSD) in Participants Treated With Nivolumab Plus Chemotherapy vs ChemotherapyNA Months
Arm 2a: Chemotherapy (XELOX or FOLFOX)Time to Symptom Deterioration (TTSD) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy21.03 Months

Source: ClinicalTrials.gov · Data processed: May 29, 2026